Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 045404706
Report Date: 08/09/2017
Date Signed 08/09/2017 05:57:06 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME:WILLIAMS, MELISSA FAMILY CHILD CARE HOMEFACILITY NUMBER:
045404706
ADMINISTRATOR:WILLIAMS, MELISSAFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(530) 342-6676
CITY:CHICOSTATE: CAZIP CODE:
95973
CAPACITY:14CENSUS: 7DATE:
08/09/2017
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Melissa WilliamsTIME COMPLETED:
06:00 PM
NARRATIVE
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An annual random inspection was made to the facility by LPA's Sandy Husband and Laura Chavez. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances or exemptions. There are presently 2 adults living in the home. During today’s inspection the home and grounds were toured and the licensee was operating within the licensed capacity. Operating hours are 6am to 5:30pm, Mon–Fri. An updated floor and yard plan was requested . Off limits areas are inaccessible. The fireplace has a secured screen. The licensee's pediatric CPR and First Aid is current, which expires 2/22/19. Items which could pose a danger to children (detergents, cleaning compounds, and medications) were stored out of the reach of children. Poisons are locked in the outdoor shop. There is a working smoke detector, carbon monoxide detector and fire extinguisher in the home. The licensee does not have a current roster of children in care. An emergency drill was conducted within the past six months. The firearms and/or other dangerous weapons in the home are locked as required. There is a swimming pool in the back section of the backyard. The pool is inaccessible, and fencing meets Title 22 Regulations. Children's records were reviewed and in substantial compliance. IMS-Incidental Medical Services were discussed. All licensing reports are public information and must be made available upon request for at least three years. Incidental Medical Services (IMS) policy was discussed. For IMS information see Evaluator Manual - Regulation Interpretations and Procedures for Family Child Care Homes Section 102417. When any IMS is provided, a Plan for Providing IMS must be submitted to the Department. The following information regarding ADA was provided: US Department of Justice (USDOJ) toll-free ADA Information Line at (800) 514-0301 (voice)/(800) 514-0383 (TTY) and link to publication: Commonly Asked Questions about Child Care Centers and the ADA, available at: http://www.ada.gov/childqanda.htm. The children use the backyard as the outdoor play area and it is completely fenced. All licensing reports are public information and must be made available upon request for at least three years. A copy of A Child Care Provider's Guide to Safe Sleep was provided during today's visit. This report was reviewed and discussed with licensee.
***Notice of Site Visit shall be posted for 30 days from today's visit.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Sandra HusbandTELEPHONE: 530-895-5913
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2017
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., SUITE 170
CHICO, CA 95926
FACILITY NAME: WILLIAMS, MELISSA FAMILY CHILD CARE HOME
FACILITY NUMBER: 045404706
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/09/2017
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/11/2017
Section Cited
102417(g)(8)
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Operation of a Family Child Care Home. All homes shall have a current roster of the children. During today's inspection licensee did not have a completed roster.
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A plan of correction was discussed and the licensee has agreed to provide an updated roster. The plan of correction shall be submitted to CCLD on or before 9/11/2017.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jordan MonathTELEPHONE: (530) 895-5991
LICENSING EVALUATOR NAME: Sandra HusbandTELEPHONE: 530-895-5913
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2017
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2017
LIC809 (FAS) - (06/04)
Page: 2 of 2